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Varied COVID Vaccination Rates May Lead to ‘Two Americas’



June 23, 2021 — Will differences in COVID vaccination rates across the country ultimately divide America?

The highly transmissible delta variant of the coronavirus is on the rise in the U.S., leading the CDC to predict that this concerning strain will soon predominate.

This outlook leads to the question about whether areas of the country with lower vaccination rates could experience worse outcomes. And if so, could the disparity lead to ‘two Americas’?

“COVID-19 and its variants, including the delta strain, will be a part of our lives for the foreseeable future,” David Hirschwerk, MD, an infectious disease expert at Northwell Health in Manhasset, N.Y., tells Medscape.

“So far, so good,” Hirschwerk adds, speaking to research looking at current vaccine efficacy against different strains of SARS-CoV-2. For the unvaccinated, however, “it is a major concern, because the current variants circulating are far more contagious and can make people much sicker.”

Theo Vos, MD, PhD, a Professor of Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, agrees.

“The delta variant appears to be more infectious than its precursor variants and that means it may take less for explosive spread, particularly among populations with low coverage of vaccination,” he says.

Clear Differences?

Variants and vaccination rate differences will require vigilance, Hirschwerk says. “Hotspots are likely to occur in areas where vaccine uptake lags,” he warns.

When asked if a ‘two Americas’ scenario is possible, “there are clear patterns with lower willingness in the Midwest and Southwest [and] with a worse picture in rural postcodes,” Vos says.

Whether regional differences in vaccination rates will translate directly to differences in COVID-19 morbidity and mortality depends onseveral factors.

“Unfortunately, low willingness for vaccination is often combined with low adherence to precautionary measure” such as distancing and masks, for example, Vos says. “What mitigates this to some extent is that spread is easier in densely populated urban areas than in rural areas.”

Rating the Risk

As of June 11, an estimated 150 million American adults (45%) are fully vaccinated against the coronavirus, according to CDC data. But the rate in some states remains lower. For example, only 28% of residents of Mississippi are fully vaccinated, asare 30% in Alabama and 32% in both Arkansas and Louisiana.

Although the vaccination rate is slightly higher in Missouri at 36%, that state now reports the highest rate of new COVID-19 cases. In fact, during the week of June 13-20, one out of every 1,349 people in Missouri was diagnosed with COVID-19. .

There are several counties in Missouri that are experiencing an increase in COVID-19 activity,” Lisa Cox, Communications Director for the Missouri Department of Health and Senior Services, tells Medscape in an email.

The department is collaborating with public health agencies in affected counties, and with the CDC to report variants and follow agency guidance, Cox says.

Furthermore, state health officials are working on more targeted efforts to engage businesses, employers, schools and churches to provide community-based vaccinations.

“We are also engaged in a targeted and aggressive state public education efforts encouraging those Missourians not yet vaccinated to do so,” Cox adds. “This is the ‘Show-Me State’ and Missourians are skeptical.”

Protecting the Unvaccinated

On a more positive note, the higher proportion of a population that is vaccinated, the lower the test positivity rate among the unvaccinated, new evidence suggests.

Researchers in Israel found that for every 20% increase in the proportion of residents vaccinated, the rate of positive tests among unvaccinated people dropped approximately twofold. The researchers compared rates in unvaccinated teenagers and children younger than 16 years to vaccinated people 16 to 50 to years old.

“The more people get vaccinated in a community, the more protected unvaccinated individuals in the same community seem to be,” lead author Oren Milman, tells Medscape in an email.

“This protection is in addition to the high protection to the vaccinated themselves,” adds Milman, a researcher at the Technion Institute of Technology in Haifa,Israel.

The study was published online June 10, 2021 in Nature Medicine.

Although naturally acquired immunity could have altered their results, Milman and colleagues adjusted for this potential confounder by including only communities across Israel where test positivity rates remained below 10%.

“Extrapolating from our results, communities with higher vaccination levels might enjoy substantially lower infection rates,” Milman says.

The research did not evaluate any specific SARS-CoV-2 variants, however. Also, actual infection rates could vary from the positive test results across communities and over time, another possible limitation.

“Although the observed vaccine-associated protection of the unvaccinated population is encouraging,” the researchers note, “further studies are required to understand whether and how vaccination campaigns might support the prospect of herd immunity and disease eradication.”

No Variance in Vaccine Advice

Even as the variants of concern change over time, protective measures do not. “The most effective means for combatting COVID transmission – irrespective of which variant is predominant – is by getting vaccinated,” Cox, from the Missouri Department of Health and Senior Services, says.

“Our biggest defender against the virus is vaccination,” Hirschwerk agrees. “We need to continue to ramp up vaccine efforts.”

WebMD Health News

(C) 2021 WebMD, LLC. All rights reserved.



Eli Lilly’s $15M investment deepens link to startup developing new class of RNA meds



Eli Lilly is making a small equity investment in a startup that recently became a research partner, deepening its connection to a company that could give the pharmaceutical giant a place in the growing field of RNA therapies.

The $15 million investment announced Tuesday comes two months after Lilly agreed to begin a partnership with London-based MiNA Therapeutics, which is developing small activating RNA therapies (saRNA). SaRNA drugs are a new class of medicines that work by a mechanism called RNA activation, which the London-based biotech likens to hitting the “on” switch for the production of a particular protein. The idea is to boost or restore cellular levels of a target protein.

With the new cash from Lilly, MiNA said it will advance and expand its internal pipeline of saRNA therapies, which is initially focused on immune-oncology and genetic diseases. The alliance with the Indianapolis-based drug giant is researching up to five targets selected by Lilly across various therapeutic areas. The agreement calls for Lilly to handle preclinical and clinical development of drug candidates that emerge from the partnership. MiNA received $25 million up front and could earn $245 million for each disease target, plus royalties from sales of any commercialized drugs from the partnership.

Lead MiNA drug candidate, MTL-CEBPA, is designed to encode a protein that acts as a master regulator of myeloid cells and other cell types. In solid tumors, myeloid cells are frequently dysregulated. By restoring CEBPA expression, MiNA said it aims to alter immune cell populations in the tumor microenvironment, potentially improving the efficacy of other cancer therapies.

A Phase 1/2 study is currently underway evaluating the MiNA drug in liver cancer. The drug is being tested in combination with sorafenib, a cancer drug that is currently the standard of care for liver cancer that can’t be removed by surgery. MTL-CEBPA is also being tested in advanced solid tumors. That Phase 1/2 clinical trial is evaluating the MiNA drug in combination with Merck cancer immunotherapy pembrolizumab (Keytruda).

Lilly isn’t MiNA’s only research partner. In January, the biotech teamed up with Paris-based Servier in a partnership developing saRNA therapies for neurological disorders. MiNA stands to earn €220 million, a sum that includes the upfront payment as well as development and commercial milestones for the first disease target, which was not specified. Similar to the Lilly alliance, Servier will handle preclinical and clinical development of the drugs covered under the alliance.

MiNA emerged last September, unveiling a £23 million (about $30 million) Series A round of funding. The biotech said at the time that the capital would support its clinical development plans. In Tuesday’s announcement, MiNA CEO said Lilly’s brings further validation.

“This investment from Lilly, together with our recently announced multi-target research collaboration, represents an important endorsement of our saRNA platform,” he said.

Photo by Flickr user Paul Sableman via a Creative Commons license

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Startup using VR for surgical training raises $27M Feedzy



Osso VR plans to expand on its virtual surgical training modules after raising $27 million in funding. Photo credit: Osso VR

In a VR demonstration, a surgeon practices an endoscopy. It’s one of several new procedures added by Osso VR, a startup that builds VR modules for surgical training.

The Palo Alto-based startup recently raised $27 million in a funding round led by GSR Ventures. Some of its past investors, including Kaiser Permanente Ventures, also contributed to the round.

The company plans to use the funds to expand its currently library of  training modules.

“After proving the clinical effectiveness of the platform and its unique ability to scale up to the millions of providers around the world, we are ready to accelerate,” Co-Founder and CEO Dr. Justin Barad said in a news release. “With this latest round, we plan to exponentially expand our library and platform so that every patient in the world can have the peace of mind knowing they are getting access to the safest, highest-value procedures.”

Founded in 2016, Osso VR initially started with a focus on orthopedic surgery, as Barad currently practices at the Orthopaedic Institute for Children. The startup currently has more than 120 modules across more than 10 specialties.

It claims it can help students and residents improve surgical performance, though this is based on two very small randomized trials.

So far, more than 20 hospital residency programs are using Osso VR, including Brown University and Johns Hopkins University.

Another income stream for the startup is from orthopedic medical device companies that use it to help train surgeons on their devices.

Osso VR isn’t the only company testing out video games as a means for training doctors. Level Ex, a company that builds phone-based training games, is taking a slightly different approach. It recently rolled out a game to help keep dermatologists up to date.



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Israel-based startup raises $6M to help payers better understand member behavior Feedzy



An Israel-based startup, which aims to give payers key information to enhance communication with their members, has raised $6 million in a Series A funding round led by 10D.

Existing investors iAngels and TAU Ventures also participated in the round, bringing the company’s total funding to $9 million.

The startup, Medorion, provides payers with software tools that orchestrate and measure member engagement, said Asaf Kleinbort, co-founder and CEO of of the company, in an email.

Like an EHR that stores clinical data, Medorion captures individual member behavior to create a database of “electronic behavior records,” he explained. To create the records, Medorion’s platform aggregates data from several sources that payers have access to, including information on gaps in care, eligibility data, claims and social determinants of health data. The platform also generates, tracks and stores digital engagement data.

Medorion’s technology aims to provide both the “who” and “why” of member behavior. For example, the electronic behavior records focus on identifying members who aren’t filling their prescriptions or are avoiding colorectal cancer screenings along with why they are doing so.

“This library of health behaviors enables payers to personalize and automate one-on-one member conversations at scale, facilitating proactive interactions that improve health delivery and financial outcomes,” Kleinbort said.

Currently, Medorion’s platform can only be used for Medicare Advantage members, and over 500,000 are using it, he said. But with the new funds, the company plans to expand the platform’s utilization beyond Medicare Advantage into other government markets.

Medorion also plans to use the new funds to grow its impact on the U.S. market, hire aggressively and boost the adoption of its behavioral intelligence platform among U.S. insurers, Kleinbort said. The company’s software has already been deployed by a handful of U.S. health plans, though Kleinbort did not provide any names.

Further, Medorion will use the funds to accelerate the development of its new risk adjustment and member experience solutions.

“Medorion’s innovative software-driven approach for health behavior intelligence and its ability to show clear value and ROI with leading payers, coupled with the growing market need, has made them a clear choice for investment,” said Itay Rand, partner at 10D, in a news release.

Medorion has joined a relatively small healthcare behavior intelligence market in the U.S. But while companies like WellToK and Icario also use behavioral science insights to improve member communication, Medorion provides a comprehensive self-service software model, “which allows insurers to own this process and do it themselves,” Kleinbort said.

Medorion provides payers with the tools necessary to understand and communicate effectively with their members, thereby building stronger relationships with them, he added.

Photo: Abscent84, Getty Images



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